The first step in the origination of caries is the formation of a dental plaque. Dental caries can lead to destruction of enamel and dentin resulting in bacterial invasion of the pulp. Invasion of the pulp and the periapical areas can promote the development of dento-alveolar abscess and spread of the infection to other anatomical areas. Several oral acid producing aerobic and anaerobic bacteria, including Streptococcus mutans, Lactobacillus acidophilus, and Actinomyces viscosus, are capable of initiating the carious lesion. The organisms that predominate in pulpitis and dento-alveolar abscess are Prevotella, Porphyromonas, Fusobacterium, and Peptostreptococcus spp. Treatment of caries involves removal of all affected tooth structure and proper replacement with a restorative material. Once pulpitis has developed the infected tissue should be removed and root canal therapy instituted, or the tooth should be extracted. Extraction, root canal therapy and/or drainage of pus usually are indicated for an abscess. Antimicrobial therapy supplementing the dental care should be considered, especially when local or systemic spread of the infection is suspected. Penicillin or amoxicillin are generally effective against most of the aerobic and anaerobic bacteria recovered. The patient whose oral cavity may harbor penicillin-resistant organisms should be considered for treatment with drugs effective against these organisms. These agents include amoxicillin-clavulanate, clindamycin or the combination of metronidazole plus amoxicillin or a macrolide.
Owing to the scarcity of double-blind, clinical trials on the use of antimicrobials in endodontics, this study may be useful in determining the best antimicrobial treatment in these infections. However, as we have not used concentration data in infected tissue to determine pharmacokinetic/pharmacodynamic indices, it would be necessary to design clinical trials in order to confirm these results.
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The aim of this study was to characterize antimicrobial resistance in Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), recovered from raw retail meat products purchased in the Washington, D.C., area. From March to August 2008, 694 samples of ground beef (n = 198), ground pork (n = 300), and ground turkey (n = 196) were collected by random sampling from stores of three grocery chains. In total, 200 S. aureus isolates (29%) were recovered by direct plating. When tested for susceptibility to 22 antimicrobials, 69% of the S. aureus isolates were resistant to tetracycline, 26% to penicillin, 17% to ampicillin, 13% to methicillin, 8% to erythromycin, 4.5% to clindamycin, 1.5% to gentamicin, and 0.5% to chloramphenicol, oxacillin, cefoxitin, or quinupristin-dalfopristin. However, 27% of the isolates were susceptible to all tested antimicrobials. More turkey and pork isolates were resistant to ampicillin, penicillin, and tetracycline than were beef isolates (P < 0.05). Additionally, 17% of the turkey and 17% of the pork isolates were resistant to methicillin (MIC ≥ 16 μg/ml), whereas no beef isolates were resistant to the antimicrobial agent. A single MRSA (methicillin MIC > 32 μg/ml) isolate containing the mecA gene with additional resistance to erythromycin, clindamycin, oxacillin plus 2% NaCl, cefoxitin, ampicillin, penicillin, quinupristin-dalfopristin, tetracycline, and gentamicin was recovered from one pork sample. The presence of antimicrobial-resistant S. aureus, coupled with the relative lack of such studies in the United States, suggests that further investigations on MRSA in the food supply are needed despite the low rate of MRSA found in this particular study.
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This study was undertaken to evaluate the physicochemical properties and skin permeation of liposome formulations containing clindamycin phosphate (CP), especially when charge was imparted to the liposome. Five different liposome formulations were prepared using Phospholipon 85G (PL) and cholesterol (CH) by conventional lipid film hydration technique. Molar ratio of CH to PL was varied in the range of 0.16-1.0. Charged liposomes were prepared in the same way with addition of 1,2-dioleoyl-3-trimethylammonium-propane chloride salt (DOTAP) and 1,2-dimyristoyl-sn-glycero-3-phosphate monosodium salt (DMPA) as charge carrier lipid for cationic or anionic charge of the liposome, respectively. Fresh full-thickness mice skin was taken and used for skin permeation study using Keshary-Chien diffusion cell with 1.77 cm(2) diffusion area at 37 degrees C. All liposome formulations prepared showed homogeneous size distribution with mean particle size of about 1 mum or less. Among the five liposome formulations prepared, formulation with the molar ratio of 0.5 showed the best result in the physicochemical properties such as polydispersity index, entrapment efficiency, size evolution, and ability of the liposome to retain CP as of entrapped in the vesicles. Charge-impartation of the formulation with cationic charge carrier lipid resulted in additional benefit in terms of inhibition of size evolution, the ability of the liposome to retain CP in the vesicles, and skin permeation. Steady state flux of the drug through the mice skin in the cationic liposome vesicles was 0.75 +/- 0.01 microg/cm(2)h while that in the control (dissolved into mixed alcohol solution) was 0.17 microg/cm(2)h. One half molar ratio of CH to PL was optimal in terms of physicochemical properties of the liposome formulation containing CP, and incorporation of cationic charge carrier lipid appeared to provide additional benefits for the stability of the liposome formulation and skin permeation of the drug.
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The authors present their experience from a prospective randomized study of therapeutic effects of a combination of pefloxacine (Abaktal) and klindamycin with cefoxitine in patients after hepatobiliary and pancreatic surgery. The therapeutic results in both investigated groups were evaluated in more than 95% patients as excellent, without statistically significant differences. The authors provided evidence of a comparable effectiveness of a combination of pefloxacine with klindamycin and the effectiveness of cefoxitine in patients after the above mentioned types of surgery, while treatment was cheaper when a combination of pefloxacine and klindamycin was used and moreover there was the possibility of oral administration of these preparations, as soon as the patients' condition made it possible.
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Multiresistant bacterial strains could become a concern in the community in France in the near future. In our study, only 14/197 (6.8%) S. aureus strains were sensitive to all tested antibiotics, whereas 21/197 (10.7%) were resistant to at least three of them. Compared to a French study performed in private practice in 2000, the level of MRSA is growing only slowly (5.8% versus 3.9%), whereas the percentage of strains of Peni-R/Oxa-S S. aureus are stable (80.5%).